State of the Heart: Exploring the History, Science, and Future of Cardiac Disease

Written by Haider Warraich

Narrated by Neil Shah

In State of the Heart, Dr. Haider Warraich takes readers inside the ER, inside patients' rooms, and inside the history and science of cardiac disease.

State of the Heart traces the entire arc of the heart, from the very first time it was depicted on stone tablets, to a future in which it may very well become redundant. While heart disease has been around for a while, the type of heart disease people have, why they have it, and how it’s treated is changing. Yet, the golden age of heart science is only just beginning. And with treatments of heart disease altering the very definitions of human life and death, there is no better time to look at the present and future of heart disease, the doctors and nurses who treat it, the patients and caregivers who live with it, and the stories they hold close to their chests.

More people die of heart disease than any other disease in the world and when any form of heart disease progresses, it can result in the development of heart failure. Heart failure affects millions and can affect anyone at anytime, a child recovering from a viral infection, a woman who has just given birth or a cancer patient receiving chemotherapy. Yet new technology to treat heart failure is fundamentally changing just what it means to be human. Mechanical pumps can be surgically sown into patients’ hearts and when patients with these pumps get really sick, sometimes they don’t need a doctor or a surgeon―they need a mechanic.

In State of the Heart, the journey to rid the world of heart disease is shown to be reflective of the journey of medical science at large. We are learning not only that women have as much heart disease as men, but that the type of heart disease women experience is diametrically different from that in men. We are learning that heart disease and cancer may have more in common than we could have imagined. And we are learning how human evolution itself may have led to the epidemic of heart disease. In understanding how our knowledge of the heart evolved, State of the Heart traces the twisting and turning road that science has taken―filled with potholes and blind turns―all the way back to its very origin.

• Language: English
• Publisher: Brilliance Audio
• Release date: Jul 23, 2019
• ISBN: 9781721383573

Haider Warraich

DR. HAIDER WARRAICH is currently a fellow in cardiology at Duke University Medical Center. His medical and Op Ed pieces have appeared in many media outlets including the New York Times, The Atlantic, the Wall Street Journal, Slate, and the LA Times among others. He is also the author of Modern Death.

Reviews for State of the Heart

[vpfluke · Rating: 4 out of 5 stars]

I wasn't sure when I started this book that I wanted to finish it, but I got pulled in to Haider Warraich's story as a cardiologist. Heart disease is the biggest cause of death despite cancer. But the author does plumb the story of cancer and heat disease and some connections between the two. I appreciate that he talks knowingly and seems to be really devoted to his patients. But there are outliers. He also shows that women's experience with heart disease has a certain separation from that of men. One example is that of takotsubo cardiomyopathy, which does not come about through hypertension or elevated cholesterol, but the stresses of life in post-menopausal women. It is sometimes called broken heart syndrome. Another situation more typical of women is spontaneous coronary artery dissection (SCAD). This is a condition that can be over-treated.

[davidwineberg · Rating: 4 out of 5 stars]

The human heart is undergoing both scrutiny and transformation as it never has before. The steep learning curve is teaching us how hearts interact with other organs, how lifestyles and medicines affect it, and how the medical fraternity can mediate its weaknesses and failures. In State of the Heart, cardiologist Haider Warraich continues his documenting of the process.It is a collection of anecdotes and rants, peppered with dips into history and controversy. He loves teasing a term or a fact, coming back to explain it only further down the page. There is a lot of detective work, with someone’s life at stake for a wrong deduction. Many, many times, Warraich explains that no one had ever seen this before, be it a symptom, a reading or a reaction. The experiences he relates are mostly his own. In one case, the patient died, but his artificial pump kept his blood circulating until Warraich called tech support and learned how to shut it off.The life of a cardiologist is the other side of this: “Being sick is like being given a new job that you didn’t ask for, didn’t want anything to do with, in fact. And now you are stuck with it. The moment you wake up, you swipe in until you fall asleep and you swipe out. There are no days off. Being sick is even worse when you have a chronic disease, like when you develop heart failure, because there is almost no chance you will get to have retirement party and ride off into the sunset. If anything, as you get older, chronic disease just gives you more work to do: more medications to take, more visits to the hospital, more limitations on your daily life, with a diminishing chance of a return to normalcy.”The chapters are neatly divided into issues. They include history, cholesterol, meds, surgery, devices, women, cancer’s relation to cardio, transplants, and end of life. The meds chapter focuses not on benefits of individual drugs, but testing, placebos and studies. The chapter on devices tells the history of catheters, balloon angioplasty, stents and electronic implants. The stories include serendipity, dumb luck, pure accident, and arrogant persistence. Warraich goes into the failings and weaknesses of these devices, and the anatomy lesson they entail is most valuable.Of particular interest to me was the chapter on women. Women manifest heart ailments differently than men. Their hormones protect them, but taking hormone replacements does no good whatsoever. Pregnancy and birth are stressful and traumatic, and the effects can linger for life. Doctors have long dismissed women’s cardiac issues, calling them cardiac neuroses. Male doctors tend not to believe their female patients. Instead, they believe their own misogynist stories that women don’t get heart attacks as much as men (they get more). They also suffer more depression and anxiety, the feeding grounds for heart ailments. Women are bigger deniers than men, postponing diagnosis and treatment due to family responsibilities, guilt, altruism and even vanity (I hadn’t even brushed my teeth – ugh – is a real excuse he cites). Cardiac issues kill far more women than breast cancer ever has. This chapter alone needs to be read out loud for all to hear.At the other extreme is the chapter on cholesterol. Warraich explains it well enough, but the chapter turns into a commercial for statins. He finds nothing whatever to keep anyone from taking them for life. He presses this point continuously. He doesn’t address the scoring system, where good and bad cholesterol are lumped together and the total is always bad. Doesn’t matter if you have a great balance between HDL and LDL, the sum total is too high for the medical establishment. He doesn’t even say what good numbers would look like. The fact is the drugmakers are continually pushing to lower that threshold, so that essentially everyone in the world has too high a score all the time and should therefore take prescription statins every day for life. There is no medical basis for it, other than the current thinking is lower-is-better. We don’t really understand why the body produces LDL at all or what the optimum level might be. This is a major gap in the chapter, and makes me wonder what he has left out elsewhere.Less newsworthy are the deleterious effects of modern life. Constant stress shows up in the heart. Bad food, lack of exercise and relaxation are life enders. People are 27% more likely to have a heart attack on their birthday than any other day. Stress is a major driver of obesity and overeating, major factors in heart disease. The human body has not evolved to keep up with constant stress. It still focuses on infection, and its solution to everything is inflammation. Inflammation means heart ailment, blocked circulation, weakened hearts and hearts out of control. ”I am here to tell you that inflammation is the central mechanism of atherosclerosis and that how we have evolved has led to more inflammation afflicting more people than any other disease in our times,” he says. Our labor-saving devices necessitate the invention of heart-saving devices. It may not be a great bargain.The thing about cardiac death is that it is usually sudden, silent and painless. Warraich shows that heart interventions near death can prolong suffering and add extra, extreme pain. For example, electric assists (LVADs) are programmed to massively shock the heart if it falters, even if death is near. It is the equivalent of being dropkicked in the chest by a horse, Warraich says. Yet doctors rarely, if ever, inform patients they can have the device turned off. Some doctors don’t even know this themselves. Technology, as in so many areas, has taken off in its own direction, and left humanity behind.State of the Heart is intense and both inspiring and massively uncomfortable. It could not be otherwise.David Wineberg